Kaiser Permanente Medicare Advantage 2021-2022 Review

Kaiser Permanente’s Medicare Advantage plans get the best ratings but are available in a handful of states only.

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Kaiser Permanente is the fifth-largest provider of Medicare Advantage plans [1], and the insurer scores higher than all other major Medicare Advantage providers in terms of Medicare star ratings and member satisfaction.

It’s also the largest not-for-profit health maintenance organization in the U.S. Kaiser uses an integrated care model, which means that members can get all their care in one place and all the providers are connected.

Although Kaiser gets top marks, its plans are only available in eight states and Washington, D.C., and the company only offers HMO plans. Here’s what you should know about Kaiser Permanente Medicare Advantage.

Kaiser Permanente Medicare Advantage pros and cons

Kaiser Permanente’s offerings have advantages and disadvantages.

Pros

  • Members are happy: Kaiser Permanente earned 846 points out of 1,000 in J.D. Power’s latest U.S. Medicare Advantage study, netting it the top spot for customer satisfaction out of nine providers measured.

  • Top scores overall: Only seven Medicare health plans received a 5 out of 5 rating from the National Committee for Quality Assurance in 2021, and four of them are Kaiser Permanente plans. Kaiser’s 2021 plans also received high Medicare star ratings.

  • Prescription benefits: Most of Kaiser’s Medicare Advantage plans include drug coverage.

Cons

  • Limited availability: Kaiser Permanente plans are available in eight states and Washington, D.C., only so the majority of U.S. adults can’t access them. (Kaiser sells plans in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia and Washington state.)

  • Limited plan types: Kaiser offers HMO plans only, so members must work within Kaiser’s network of medical providers.

Available Medicare Advantage plans

Kaiser Permanente offers HMO Medicare Advantage plans. Many plans offer dental, vision and hearing benefits, and worldwide emergency care. Kaiser doesn't offer any stand-alone Medicare prescription drug plans.

Plan availability may vary by county. Plan offerings may include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Kaiser Permanente offers one type of SNP:

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

Additional benefits

Kaiser Permanente Medicare Advantage offers many members access to routine vision, dental and hearing coverage. Some plans offer other benefits as well. Here are a few standouts, although their availability varies by plan:

  • Over-the-counter allowance: Some plans include an OTC benefit that allows you to purchase certain items, like vitamins and cold medications, at no extra cost by placing an order over the phone or from Kaiser’s online catalog. The allowance amount varies by plan and resets each quarter.

  • Home-delivered meals: Some plans include the option to have meals delivered to your home after you’ve been discharged from the hospital due to congestive heart failure.

  • Silver&Fit Healthy Aging and Exercise Program: Some plans include access to local participating fitness centers along with home fitness tools.

  • Advantage Plus: For an additional monthly premium, members can access additional benefits such as an eyewear allowance, hearing aid allowance and comprehensive dental benefits if the plan doesn’t already cover them.

Customer service

Kaiser Permanente Medicare Advantage members can contact their plan’s customer service in a few ways:

  • Call a customer service representative. The phone number and hours of available support will depend on location.

  • Chat with a member services representative, Monday to Friday from 8 a.m. to 5 p.m. in their time zone, except on major holidays.

  • Send an email with nonurgent questions or comments.

Kaiser Permanente Medicare Advantage service area

Kaiser Permanente offers Medicare Advantage plans in eight states and Washington, D.C., including 115 counties [2].

Overall, Kaiser Permanente is the fifth-largest health insurer in the country [3], and it is the largest in terms of nonprofit health plans [4]. Some 1.7 million Medicare beneficiaries are enrolled in Kaiser Permanente Medicare Advantage plans, and the company added 59,000 new members for the 2021 plan year.

Cost

Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and more than a third (36.6%) of Kaiser Permanente’s Medicare Advantage plans are $0-premium plans in 2022 [5].

For Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $15 to $296. For Dual-Eligible Special Needs Plans, or D-SNPs, monthly premiums range from $28.90 to $33.90 [6].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $148.50 in 2021 ($170.10 in 2022). However, some plans cover part or all of this cost.

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only Kaiser Permanente plans or compare across carriers. You can also shop directly from Kaiser Permanente’s website by entering your ZIP code.

For 2021 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $10 to $295. For 2021 Dual-Eligible Special Needs Plans, or D-SNPs, monthly premiums range from $25.40 to $30.50. About a quarter (26%) of Kaiser Permanente’s Medicare Advantage plans are $0-premium plans in 2021.

5 Popular Kaiser Permanente Plans in 2021

Plan

Medicare star rating

Monthly consolidated premium (includes Parts C + D)

Annual drug deductible

In-network maximum out-of-pocket amount

Kaiser Permanente Senior Advantage Los Angeles and Orange Counties (California)

5.

$0.

$0.

$3,400.

Kaiser Permanente Senior Advantage Enhanced (Oregon)

5.

$127.

$0.

$3,000.

Kaiser Permanente Senior Advantage Core (Colorado)

5.

$0.

$95.

$4,400.

Kaiser Permanente Medicare Advantage Standard MD (Maryland)

5.

$25.

$0.

$6,900.

Kaiser Permanente Medicare Advantage Vital (Washington state)

4.5.

$28.

$0.

$5,800.

Medicare star ratings

Average star rating: 5

If you want Medicare’s take on Kaiser Permanente’s plans, look no further than the Centers for Medicare & Medicaid Services' own star ratings, which rank each plan from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, Kaiser Permanente’s 2022 Medicare Advantage (Part C) plans and prescription drug (Part D) plans scored 5 stars [7]. This performance is unmatched by any other provider. The average star rating for plans from all providers was 4.37 [8].

To get an overall star rating, the CMS ranks contracts on 40 plan factors. Kaiser Permanente delivers on the majority of them. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here’s where Kaiser Permanente plans received average scores of 4.5 (out of 5) and above:

  • Colorectal cancer screening.

  • Annual flu vaccine.

  • Care for older adults — medication review.

  • Care for older adults — pain assessment.

  • Diabetes care — eye exam.

  • Diabetes care — kidney disease monitoring.

  • Diabetes care — blood sugar controlled.

  • Rheumatoid arthritis management.

  • Medication reconciliation post-discharge.

  • Complaints about the health plan.

  • Members choosing to leave the plan.

  • Reviewing appeals decisions.

  • Health plan: Call center — foreign language interpreter and TTY availability.

  • Drug plan: Call center — foreign language interpreter and TTY availability.

  • Complaints about the drug plan.

  • Members choosing to leave the plan.

  • Rating of drug plan.

  • Getting needed prescription drugs.

  • Medication adherence for hypertension.

  • Medication adherence for cholesterol.

  • Medication Therapy Management program completion rate for Comprehensive Medication Review.

  • Statin use in persons with diabetes.

  • Breast cancer screening.

  • Osteoporosis management in women who had a fracture.

  • Rating of health plan.

  • Medicare Plan Finder price accuracy.

  • Plan makes timely decisions about appeals.

  • Statin therapy for patients with cardiovascular disease.

  • Rating of health care quality.

  • Monitoring physical activity.

  • Drug plan quality improvement.

  • Special Needs Plan, or SNP, care management.

Kaiser Permanente contracts averaged a sub-3.0 score in only one category:

  • Reducing the risk of falling.

In 2021, Kaiser Permanente’s Medicare Advantage (Part C) plans get an average rating of 4.8, and the company’s prescription drug plans (Part D) get an average score of 4.9. The average star rating for plans from all providers was 4.06. In practice, all of Kaiser Permanente’s 2021 contracts score 5 stars except for one contract — the Kaiser Foundation Health Plan of Washington — which gets 4.5 stars.

That means that of the Kaiser Permanente members who are in contracts with a Medicare star rating, 100% are in contracts rated 4.0 or above in 2021.

You can find a plan’s rating with the Medicare Plan Finder.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included three here:

Fitch Ratings is a credit rating agency that assigns ratings based on its opinion of a company’s ability to meet financial commitments. In May 2021, Fitch Ratings affirmed an Insurer Financial Strength rating of AA- (very strong) for Kaiser Foundation Health Plan, or KFHP, and its insurance company subsidiaries. Among other factors, Fitch Ratings called out KFHP’s double-digit market share in seven out of eight states and Washington, D.C., favorable financial leverage numbers and its sizable revenue and earnings base [9].

In its 2021 Medicare Advantage Study — the seventh it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Kaiser Foundation Health Plan scored 846 points out of 1,000 and came in first out of the top nine Medicare Advantage providers [10].

The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA's accreditation survey. The ratings highlight the results of care and what patients say about their care.

In its September 2021 ratings of Kaiser Permanente plans, the NCQA awarded ratings of 4.5 and 5.0. The top-rated plans with scores of 5.0 were Kaiser Foundation Health Plan - Southern California, Kaiser Foundation Health Plan of Colorado, Kaiser Foundation Health Plan of the Mid-Atlantic States and Kaiser Foundation Health Plan - Northern California [11].

Compare alternatives

See how Medicare Advantage competitors stack up to Kaiser Permanente.

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating (2022)

87%.

46 states and Washington, D.C.

3.8.

59%.

44 states.

4.1.

87%.

26 states and Washington, D.C.

4.2.

93%.

50 states, Washington, D.C., and Puerto Rico.

4.1.

100%.

8 states and Washington, D.C.

5.

76%.

50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

4.2.

26%.

36 states.

3.6.

About Kaiser Permanente

Kaiser Permanente, headquartered in Oakland, California, was founded in 1945 and serves 12.5 million people across eight states and Washington, D.C. The company is made up of Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and its subsidiaries, and the Permanente Medical Groups.

Kaiser Permanente offers insurance for individuals and families, employer group plans, Medicaid/Medi-Cal and Medicare Advantage. In 2020, Kaiser posted annual operating revenue of $88.7 billion.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a health plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).

ARTICLE SOURCES:

  1. Kaiser Family Foundation, “Medicare Advantage in 2021: Enrollment Update and Key Trends,” accessed Oct. 27, 2021.

  2. Centers for Medicare & Medicaid Services, “2022 MA Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 27, 2021.

  3. American Medical Association, “Competition in Health Insurance,” accessed Oct. 27, 2021.

  4. Centers for Medicare & Medicaid Services, “2022 MA Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 27, 2021.

  5. Centers for Medicare & Medicaid Services, “2022 SNP Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 27, 2021.

  6. Centers for Medicare & Medicaid Services, “2022 Star Ratings Data Table (Oct 06 2021) (ZIP),” accessed Oct. 27, 2021.

  7. Centers for Medicare & Medicaid Services, “2022 Star Ratings Fact Sheet_10_8_2021 (PDF),” accessed Oct. 27, 2021.

  8. NCQA, “Health Plans,” accessed Oct. 27, 2021.

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